Grid pattern laser treatment and methods for treating an eye

ABSTRACT

Embodiments of the invention provide systems and methods for treating the retina and/or other areas of a patient&#39;s eye. The procedures may involve using one or more treatment beams (e.g., lasers) to cause photocoagulation or laser coagulation to finely cauterize ocular blood vessels and/or prevent blood vessel growth to induce one or more therapeutic benefits. In other embodiments, a series of short duration light pulses (e.g., between 5-15 microseconds) may be delivered to the retinal tissue with a thermal relaxation time delay between the pulse to limit the temperature rise of the target retinal tissue and thereby limit a thermal effect to only the retinal pigment epithelial layer. Such procedures may be used to treat diabetic retinopathy, macular edema, and/or other conditions of the eye. The treatment beam may be delivered within a treatment boundary or pattern defined on the retina of the patient&#39;s eye.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims priority to Provisional U.S. Patent ApplicationNo. 61/549,036 filed Oct. 19, 2011, entitled “Grid Pattern TherapeuticTreatment,” the entire disclosure of which is hereby incorporated byreference, for all purposes, as if fully set forth herein.

BACKGROUND

Therapeutic lasers are often used to treat various conditions of theeye. For example, a specific type of condition that may be treated withsuch lasers is diabetic retinopathy. Diabetic retinopathy, is damage tothe retina that is due to complications of diabetes. If left untreated,diabetic retinopathy can eventually lead to blindness. Diabeticretinopathy typically results from microvascular retinal changes. Forexample, diabetic induced effects may damage tissue of the eye, whichmay change the formation of the blood-retinal barrier and make theretinal blood vessels become more permeable. In treating suchconditions, one or more light beams may be directed into the eye and/oronto retinal tissue to cause photocoagulation of the tissue so as tofinely cauterize ocular blood vessels and/or prevent blood vessel growthto induce various therapeutic benefits. Laser photocoagulation iscommonly used for early stages of retinopathy.

In providing laser photocoagulation treatments, however, it is importantto avoid damaging sensitive tissue of the eye, such as the fovea,macula, and the like. In certain instances, it may be desired to treattissue close to one or more of these areas while ensuring that damage tosuch areas is avoided. Conventional laser photocoagulation techniques donot offer optimal solutions to treating areas close to such sensitivetissue while ensuring that damage to such tissue will be avoided orgreatly reduced. Accordingly, there is a need in the art for improvedlaser photocoagulation methods for treating various conditions of theeye, such as diabetic retinopathy.

SUMMARY OF THE INVENTION

Embodiments of the invention described herein provide systems andmethods for treating retina tissue and/or other areas of a patient'seye. The procedures may involve using one or more light beams (e.g.,lasers) to cause photocoagulation to finely cauterize ocular bloodvessels and/or prevent blood vessel growth to induce one or moretherapeutic benefits. Such procedures may be used to treat diabeticretinopathy, macular edema, and/or other conditions of the eye.According to one aspect, a method for treating an eye of a patient isprovided. The method may include projecting a first beam onto retinaltissue of the patient's eye. A boundary separating the retinal tissue toa first area and a second area may be defined on the retinal tissue viathe first beam. A therapeutic treatment may be delivered via a secondbeam to the retinal tissue of the patient's eye by selectively directingthe second beam onto the retinal tissue of the patient's eye within thefirst area.

According to one embodiment, the method may also include positioning theboundary adjacent an identified region of the patient's eye so that theidentified region is within the second area. The identified region mayinclude or define tissue that is not to be treated with the treatment.The second beam may be directed within the first area so as to avoiddelivering the therapeutic treatment to the tissue of the identifiedregion. The boundary may include a pattern of geometric shapes that eachdefine an area within which the second beam is to be directed to deliverthe treatment, and the second beam may be directed within each of thegeometric shapes.

The pattern of geometric shapes may be defined on the retinal tissue ofthe eye by controlling (e.g., via a scanning device) a location of thefirst beam on the retinal tissue such that the first beam outlines thepattern of geometric shapes on the retinal tissue. The location of thefirst beam may be adjusted between each of a plurality of pulses. Thepattern of geometric shapes may include: a grid having a plurality ofsquares, a grid having a plurality of rectangles, a semicircle pattern,a pattern of circles, a hexagonal pattern, and the like. The second beammay be directed over a geometric center of each of the geometric shapes.A spot of the second beam that is incident on the retinal tissue may beentirely within a periphery of the geometric shape formed by the firstbeam.

According to some embodiments, the first beam may not be delivered whena pulse of the second beam is delivered and vice versa. According tosome embodiment, a plurality of pulses of the second beam may bedelivered within the boundary to provide the treatment. According tosome embodiments, a scale of the boundary or an orientation of theboundary or both may be adjusted prior to or simultaneously withproviding the therapeutic laser treatment. According to someembodiments, defining the boundary may include directing the first beamalong a periphery of the boundary. The first beam may have a visiblespot size on the retina that is smaller than a spot size of the secondbeam. Delivering the therapeutic treatment may include causingphotocoagulation of the retinal tissue. According to some embodiments,the second beam may be delivered in a series of pulses of sufficientlyshort duration so as to avoid inducing traditional photocoagulation ofthe retinal tissue while inducing photoactivation of a therapeutichealing response.

According to another embodiment, a method for providing therapeutictreatment to a patient's eye is provided. The method may includeprojecting a treatment pattern onto a retina of the patient's eye. Thetreatment pattern may define a first area of retinal tissue and a secondarea of retinal tissue. A therapeutic treatment may be delivered (e.g.,via a treatment beam) to retinal tissue of the first area by selectivelydirecting the treatment beam within the first area.

According to some embodiments, the treatment pattern may include apattern of geometric shapes and each geometric shape may define atreatment area within which the treatment beam is to be directed. Thetreatment beam may be sequentially directed within each of the geometricshapes. The treatment pattern may include or define a grid having aplurality of rows and columns. The treatment beam may be sequentiallyscanned along, and preferably within, the plurality of rows and columnsto deliver the treatment beam to the retinal tissue, preferably withinor near a geometric center of each of the geometric shapes.

The grid may include an M×N array of squares or rectangles arranged in alinear or semicircular pattern. According to some embodiments, themethod may also include projecting a second treatment pattern onto theretina at a location that has not received the treatment. The secondtreatment pattern may define a third area of retinal tissue and a fourtharea of retinal tissue. The therapeutic treatment may be delivered toretinal tissue of the third area by selectively directing the treatmentbeam within the third area.

According to another aspect, a system for providing a therapeutictreatment to a patient's eye is provided. Among other things, the systemmay include: a first beam source, a second beam source, an aimingdevice, and a processor. The first beam source may be configured totransmit a first beam along a first beam path. The second beam sourcemay be configured to transmit a second beam along a second beam path.The aiming device may be disposed along the first and second beam pathsand configured to scan the first beam and the second beam along a retinaof the patient's eye. The processor may be coupled to the aiming deviceand configured to: define, via the first beam, a treatment boundaryseparating a region of the retina into a first area and a second area,and direct the second beam onto the retina within the first area definedby the first beam so as to deliver the therapeutic treatment to theretinal tissue of the patient's eye.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention is described in conjunction with the appendedfigures:

FIGS. 1A-1G illustrate various perspective views of an adapter that maybe coupled with an ophthalmic imaging instrument to enable theophthalmic imaging instrument to provide a boundary defined therapeutictreatment.

FIGS. 2A-2E illustrate various views of the adapter of FIGS. 1A-1Gcoupled with an ophthalmic imaging instrument.

FIG. 3 illustrates a block diagram of a system for providing therapeutictreatments in accordance with an embodiment of the invention.

FIGS. 4A-4C illustrate block diagrams of a display interface that may beused with the system of FIG. 3.

FIGS. 5A-5F illustrate various treatment boundaries and/or treatmentpatterns that may be used for the boundary defined therapeutictreatments.

FIGS. 6A-6F illustrate laser light being delivered within or withrespect to the treatment boundaries and/or treatment patterns of FIGS.5A-5F.

FIGS. 7A-7F illustrate a process of sequentially delivering laser lightwithin a treatment pattern.

FIG. 8 illustrates a treatment pattern being positioned adjacent afeature or tissue of a patient's retina.

FIGS. 9A-9C illustrate an oblong or oval cross sectional profile of atreatment laser that may be used to compensate for continuous movementof the treatment laser during a treatment procedure.

FIGS. 10A-10C illustrate a retinal image, profile, or map that may beused in a therapeutic treatment procedure.

In the appended figures, similar components and/or features may have thesame numerical reference label. Further, various components of the sametype may be distinguished by following the reference label by a letterthat distinguishes among the similar components and/or features. If onlythe first numerical reference label is used in the specification, thedescription is applicable to any one of the similar components and/orfeatures having the same first numerical reference label irrespective ofthe letter suffix.

DETAILED DESCRIPTION OF THE INVENTION

The ensuing description provides exemplary embodiments only, and is notintended to limit the scope, applicability or configuration of thedisclosure. Rather, the ensuing description of the exemplary embodimentswill provide those skilled in the art with an enabling description forimplementing one or more exemplary embodiments. It should be understoodthat various changes may be made in the function and arrangement ofelements without departing from the spirit and scope of the invention asset forth in the appended claims.

Embodiments of the invention provide systems and methods for treatingthe retina and/or other areas of a patient's eye. The procedures mayinvolve using one or more light beams (e.g., lasers) to causephotocoagulation to finely cauterize ocular blood vessels and/or preventblood vessel growth to induce one or more therapeutic benefits. Suchprocedures may be used to treat diabetic retinopathy, macular edema,and/or other conditions of the eye. In some embodiments,photocoagulation may result in a series of visible spots that appear inthe retina. In other embodiments, a series of short duration lightpulses (e.g., between 5-15 microseconds) may be delivered to the retinaltissue with a thermal relaxation time delay between each pulse to limitthe temperature rise of the target retinal tissue and thereby limit athermal effect to only the retinal pigment epithelial layer. Shortduration pulse treatments, such as MicroPulse™ Laser Therapy of systemsand devices sold by Iridex® Corporation (hereinafter short durationpulse treatments or procedures), may not result in visible spots thatappear on the retina and may result in less overall tissue damage.

The treatment light (i.e., laser light) delivered to treat and/orcoagulate the retinal tissue may be delivered at therapeutic levelswithin a defined treatment boundary that may include a pattern ofrecurring geometric shapes. The treatment boundary may define an areawithin which treatment light at therapeutic levels is directed andoutside of which treatment light is substantially not directed or isprovided at sub-therapeutic levels, such as in the case of refractedlight, incident light, and the like. Thus, the treatment boundary maydefine an area within which therapeutic treatment is provided andoutside of which therapeutic treatment is not provided or minimallyprovided. The treatment boundary and/or pattern may be projected and/ordefined on the retinal surface of the patient's eye to display the areato be treated. Because the treatment boundary may define or distinguishthe area of the retina that does not receive or minimally receives thetherapeutic treatment, a peripheral edge of the treatment boundary maybe positioned adjacent sensitive tissue of the retina and/or anywherethat the therapeutic treatment is not desired to ensure that thesensitive tissue or area will not receive or will minimally receive thetherapeutic treatment. It should be realized that some therapeutic lightmay be incident upon tissue outside of the treatment boundary due torefraction, light scattering, and the like, but such light will beminimal and likely have minimal effect upon the tissue outside of thetreatment boundary. Thus, embodiments of the invention provide precisecontrols for determining areas of the retina that will receivetherapeutic treatment and areas that will not.

The peripheral edge of the treatment boundary, along with the remainderof the treatment boundary, may be defined and displayed on a userinterface, map or image of the retina, and/or on the retina itself sothat a physician or user providing the therapeutic treatment is aware ofthe outer boundary of the treatment area. Since the outer boundary ofthe treatment area is displayed, the physician may closely abut or placethe treatment area proximate to sensitive tissue and/or to any otherarea while ensuring that the sensitive tissue or other area will not betreated or minimally treated.

In some embodiments, a treatment pattern includes an array of aimingspots instead of, or in addition to, an enclosed boundary or pattern.The array of aiming spots may be defined on the patient's retina asdescribed herein and the treatment beam may be fired or deliveredcoaxially with respect to one or more of the aiming spots.

The treatment boundary and/or treatment pattern may be defined and/orprojected on the retinal surface using one or more aiming beams. Theaiming beam may be a laser beam or any other type of light beam (e.g., abeam produced by a high powered light emitting diode (LED)). The aimingbeam may be generally referred to herein as an aiming laser, although itshould be realized that light beams other than lasers may be used. Theaiming beam may be a low intensity laserlight beam that does not damagethe retinal tissue. In some embodiments, the aiming beam has awavelength of between about 600 nm (nanometers) and about 700 nm, andmore commonly about 650 nm. The aiming beam may be provided by a laserdiode and may have an incident spot or cross section on the retinaltissue that is substantially smaller than an incident spot of thetreatment laser that is used to treat the retinal tissue. Alternatively,in some embodiments, the aiming beam may be provided by a high poweredlight emitting diode (LED) in place of, or in addition, to the aiminglaser. The aiming beam may be scanned on the patient's retina, or on adisplay interface or image of the retina, to trace or outline thetreatment boundary and/or treatment pattern so as to visually displaythe treatment boundary and/or pattern to a physician. The treatmentboundary and/or pattern defined or projected onto the retinal surfacemay be captured by a camera and displayed to the physician or other useron a display interface.

One or more treatment beam pulses or doses may be delivered within thetreatment boundary and/or pattern to treat the retinal tissue. Thetreatment beam may be generally referred to herein as a treatment laser,although, like the aiming beam, it should be realized that other lightbeams may be used, such as a high intensity light beam from a highpowered light emitting diode (LED). The treatment pulses or doses may bedelivered as a scanning device continuously scans an axis of thetreatment beam within the treatment boundary and/or may be delivered asthe scanning device sequentially moves the treatment beam axis betweenspecified locations within the treatment boundary. In embodimentsinvolving treatment patterns having recurring geometric shapes, one ormore treatment beam pulses may be delivered within some or each of thegeometric shapes. In a specific embodiment, a single treatment beampulse may be delivered substantially in a geometric center of each ofthe geometric shapes. A cross section of the incident beam light (e.g.,a laser beam spot) may be roughly equivalent in size with the geometricshape. In some embodiments, the treatment beam (e.g., laser beam) mayhave a wavelength of between about 400 nm and 600 nm, and more commonlybetween about 520 nm and 560 nm.

The therapeutic treatment (also referred to herein as a boundary definedtherapeutic treatment) may be provided via an adapter that is configuredto be mounted onto and operate with a preexisting ophthalmic imaginginstrument, such as a slit lamp. The adapter may also operate with apreexisting treatment beam source, such as a laser delivery instrument.An external controller or computer system may be communicatively coupledwith the adapter and laser delivery instrument to define the treatmentboundary and/or pattern on the retinal tissue and deliver the treatmentbeam within the treatment boundary/pattern. The adapter and/orcontroller may allow a preexisting slit lamp and laser deliveryinstrument to provide the boundary defined therapeutic treatmentdescribed herein, which slit lamp and laser delivery instrument wouldotherwise be incapable of delivering.

Embodiments of the invention also describe methods and system of usingretinal imaging and/or tracking to provide a therapeutic treatment(e.g., the boundary defined therapeutic treatment) described herein oranother therapeutic treatment. The therapeutic treatment and/or atreatment boundary may be programmed and/or documented with reference toa retinal image or model of a patient's retina. A system performing thetherapeutic treatment may reference the retinal image or model and theprogrammed therapeutic treatment or treatment boundary to determine alocation or area of the patient's retina to provide the therapeutictreatment. The system may then automatically begin the therapeutictreatment or display the treatment boundary/pattern and correspondingretina treatment area to a physician for review, adjustment, and/orauthorization to proceed. A plurality of such therapeutic treatments maybe programmed into the system so that the system may quickly andconveniently begin performing an additional therapeutic treatmentshortly after completing a current or previous treatment. The providedtreatments may be documented or recorded on the retinal image or modelfor simultaneous or subsequent review by the physician or user. Forexample, treatment spots or other indicia may be superimposed on theretinal image for each location or position that a pulse or dose of thetreatment beam is received. The superimposed spots or indicia maydocument the areas of the retina for which therapeutic treatment wasprovided. This may be particularly useful when no visible effects of thetherapeutic treatment are present on the retinal tissue, such as inshort duration pulse procedures.

Referencing the therapeutic treatment and/or treatment boundaryprocedure with respect to the retinal image or model may also allow thesystem to compensate for movement of the patient's eye during theprocedure. For example, retinal tracking may allow a camera to capturesubstantially smooth images of the retina and/or allow the system toadjust to a movement of the patient's eye and continue to deliver thetherapeutic treatment at substantially the same location. Having brieflydescribed some embodiments of the invention, additional aspects willbecome apparent with reference to the figures.

Embodiments of Therapeutic Treatment Hardware and Components

FIGS. 1A-1G illustrate perspective views of an embodiment of an adapterthat may be coupled with an ophthalmic imaging instrument, such as aslit lamp, to adapt the ophthalmic imaging instrument to provide theboundary defined therapeutic treatment described herein. FIGS. 2A-2Eillustrate the adapter 100 coupled with a slit lamp 200. FIGS. 1A-1Cprovide various perspective views of the adapter 100. FIGS. 1D-1G alsoprovide perspective views of adapter 100 with a front cover of theadapter removed to show various components housed within adapter 100.Adapter 100 includes a housing 102 having a front and back cover coupledtogether. Adapter 100 also includes a mounting member 104 thatreleasably couples adapter 100 with the ophthalmic imaging instrument(e.g., slit lamp 200). Adapter 100 also includes adapting component 105that facilitates in coupling adapter 100 with the ophthalmic imaginginstrument 200. Component 105 may include a rotatable mounting knob 103that presses mounting member 104 firmly against a mounting feature (notshown) of the ophthalmic imaging instrument. Component 105 also includesa mirror 106 that reflects light delivered from adapter 100 toward aneye of a patient and that may be transparent or semi-transparent so thatsome light is delivered back to a camera (e.g., camera 360) and/orbinocular adapter 152 that couples with a binocular (e.g., binocular210) or other eyepiece. Component 105 may further include an adjusterbar 135 that allows rotational adjustment of adapter 100 and/or theophthalmic imaging instrument 200.

Adapter 100 further includes an interface or port 110 that couples witha fiber optic cable of an external laser delivery instrument (e.g.,laser delivery instrument 310). The fiber optic cable of the externallaser delivery instrument provides or delivers a treatment laser 112 toadapter 100. Adapter 100 includes mirror 136 that reflects treatmentlaser 112 toward an aiming device 130 (also referred to herein as ascanning device or system). Mirror 136 may be a perforated mirror, halfmirror, dichroic mirror, and the like and may be mounted on a lensholder. Aiming device 130 may be a galvanometer-based scanner (commonlyreferred to as “galvos”) manufactured by Cambridge Technology®. Aimingdevice 130 includes a pair of rotatable elements or mirrors, 132 and134, mounted atop motors that rotate elements or mirrors, 132 and 134,about orthogonal axes. Each mirror, 132 and 134, may provide 1-D beamdeflection, so that the pair of mirrors provides 2-D beam deflection.Aiming device 130 is used to scan treatment laser 112 and/or otherlasers (e.g., aiming laser 122) relative to the eye so that the lasersmay be aimed and fired at desired locations on or within the eye. Forexample, aiming device 130 may be used to scan aiming laser 122 todefine the treatment boundary and/or treatment pattern on retinal tissueand to scan a beam of treatment laser 112 within the treatmentboundary/pattern so as to provide the boundary defined therapeutictreatment.

Aiming laser 122 passes through mirror 136 to aiming device 130. In someembodiments, adapter 100 may include another interface or port (notshown) that receives the aiming laser 122 from an external laserdelivery instrument or source (not shown), which may be the same laserdelivery instrument that delivers treatment laser 112 or a differentunit. In other embodiments, adapter 100 includes a laser deliveryinstrument or source 120 within housing 102. For example, laser deliveryinstrument 120 may include a laser diode 124, or alternatively a highpowered LED, that provides the aiming laser 122. Laser deliveryinstrument 120 may also include a computing device 126, such as a memorydevice and/or processor, that is communicatively coupled with anexternal controller (e.g., controller 330 and/or 310) to control thedelivery of aiming laser 122.

In one embodiment, aiming laser 122 may be provided along a laser pathsubstantially orthogonal to a laser path of treatment laser 112. Thelaser paths of aiming laser 122 and treatment laser 112, however, may bealigned or substantially coaxial after aiming laser 122 pass throughmirror 136. For example, laser path 128 illustrates a path of a laserbeing delivered from aiming device 130 and reflected off mirror 106toward an eye of a patient. Laser path 128 may correspond to either orboth aiming laser 122 and treatment laser 112 since at this point thelaser paths may be coaxially aligned.

Aiming laser 122 may have a wavelength selected within the visiblespectrum to provide improved visibility of the treatment boundary and/orpattern on the retina. For example, in some embodiments, aiming laser122 has a wavelength between about 600 nm and about 700 nm, and morecommonly about 650 nm. Aiming laser 122 may be a low intensity beam thatdoes not damage retinal and/or other tissue of the eye. Aiming laser 122may also have an incident spot or cross section that is substantiallysmaller than an incident spot of treatment laser 112. In someembodiments, treatment laser 112 may also have a wavelength selectedwithin the visible spectrum, although non-visible wavelengths may alsobe used. In a specific embodiment, treatment laser 112 has a wavelengthof between about 400 nm and 600 nm, and more commonly between about 520nm and 560 nm. Treatment laser 112 may be used to coagulate retinaland/or other tissue of the eye and/or provide other therapeutic healing.

Adapter 100 also include a magnification mechanism 140 that may be usedto increase the cross section or incident spot of the treatment laser112 and/or aiming laser 122. Magnification mechanism 140 is positionedalong a laser path (e.g., laser path 128) distally of aiming device 130.Magnification mechanism 140 includes a plurality of lenses 142 mountedon a rotatable lens holder 144. Each lens has a specified optic powerthat increases or decreases the cross section or incident spot of thetreatment laser 112 and/or aiming laser 122. Lens holder 144 may berotated so that a desired lens is positioned along laser path 128. Insome embodiments, lens holder 144 is rotated by rotating a control knob146 positioned on an exterior surface of housing 102, although in someembodiments, lens holder 144 may be rotated electronically.

FIGS. 2A-2E illustrate various perspective views of adapter 100 mountedwith slit lamp 200, which may be any slit lamp commonly used, such asthose manufactured by Haag-Streit International®, Carl Zeiss®, and thelike. Slit lamp 200 includes binoculars 210 that provide a stereoscopicview of the patient's eye. Binoculars 210 may be coupled with binocularadapter 152. Slit lamp 200 also includes a patient mounting frame 220having vertical frame members 222, a chin rest 224, and head rest 226.Although not shown, slit lamp 200 may also include a joystick and footpedal that may be used to provide functional control of various slitlamp components and/or operations and/or to deliver the therapeutictreatment beam. Slit lamp 200 and/or chin rest 224 may be verticallyadjusted to accommodate patients of different size.

FIG. 3 illustrates embodiments of various controls that may be used toprovide the therapeutic treatments described herein. Specifically, FIG.3 illustrates adapter 100 coupled with an external laser deliveryinstrument 310 via optical fiber 324. Optical fiber 324 connects to port110 and delivers treatment laser 112 to adapter 100. Optical fiber 324may be coupled with one of a plurality of optical fiber ports 322 onlaser delivery instrument or source 310. The optical fiber ports 322 mayallow two optical fibers 324 to be connected to laser deliveryinstrument 310. Laser delivery instrument 310 also includes a displayinterface 320 (e.g., a touch screen interface) that displays settingsand controls for the therapeutic treatment to be provided as shown inFIGS. 4A-4C. Laser delivery instrument 310 may also include a remotecontrol unit 326 (wireless or wired) that allows a user to remotelyoperate and adjust various settings of the laser delivery instrument.Likewise, laser delivery instrument 310 may include a foot pedal 340that is operated to perform the therapeutic treatment and/or delivertreatment laser 112. Foot pedal 340 may be wirelessly coupled with laserdelivery instrument 310. Examples of laser delivery instrument 310include the IQ 532, IQ 577, Oculight TX, and the like, manufactured byIRIDEX Corp®.

Laser delivery instrument 310 may be a conventional unit that is notable to offer the boundary defined therapeutic treatment in itsconventional state. To enable the laser delivery instrument 310 toprovide this treatment, a computer system 330 may be communicativelycoupled with laser delivery instrument 310 and/or adapter 100. Computersystem 330 may be a separate set top box that plugs into one or moreports of the laser delivery instrument 310 to communicate with laserdelivery instrument 310. Additionally, computer system 330 may includeone or more processors and memory devices that allow computer system 330to interface with various other systems or units to perform thetherapeutic treatment. Information may be routed between computer system330 and a computer system or processor of laser delivery instrument 310so that computer system 330 controls the delivery of treatment laser 112and graphical displays information to a user via display interface 320.For example, computer system 330 may interface with the controls oflaser delivery instrument 310 (e.g., touch screen controls, remotecontrol 326, foot pedal 340, and the like) so that adjustment of thecontrols of laser delivery instrument 310 configure or adjust thesettings and parameters of computer system 330. As shown in FIGS. 4A-4C,computer system 330 may control display interface 320 to display varioussetting and/or operations of the boundary therapeutic treatment, such asthe shape, orientation, scale, geometric pattern, laser intensity andthe like, of the specific treatment boundary/pattern being projected.Computer system 330 may control (via one or more instructions) laserdelivery instrument 310 to delivery treatment laser 112 doses atspecified points and at specified times. For example, computer system330 may control laser delivery instrument 310 so that treatment laser112 beams or doses are delivered within the defined treatment boundary,treatment pattern, and/or defined geometric shapes as described below.Likewise, computer system 330 may control laser delivery instrument 310so that the delivered treatment laser 112 coagulates the retinal tissueof the eye or provides a less traumatic series of short duration pulses(e.g., short duration pulse treatments) with a defined relaxationinterval between pulses as described below.

In essence, computer system 330 may be communicatively coupled withlaser delivery instrument 310 so that laser delivery instrument 310functions as a pass through input and interface device for computersystem 330 to enable a physician or user to interface with computersystem 330 and adjust various parameters of the therapeutic treatment.Computer system 330 also functions with the preexisting controls oflaser delivery instrument 310 (e.g., foot pedal 340, internal hardwarecomponents, and the like) to deliver treatment laser 112 to adapter 100.

Computer system 330 is also communicatively coupled with adapter 100 toperform various aiming or other functions. For example, computer system330 may control aiming or scanning device 130 and/or laser deliveryinstrument 120 to aim or scan treatment laser 112 and aiming laser 122onto specified areas of the retina. Computer system 330 may interleavetreatment laser 112 and aiming laser 122 during the therapeutictreatment procedure. Computing device 330 controls the delivery ofaiming laser 122 and controls scanning device 130 to define or projectthe treatment boundary or treatment pattern onto the retina.

In some embodiments, control unit 330 switches aiming laser 122 on whiletreatment laser 112 is switched off to define the treatment boundary.Control unit 330 then switches aiming laser 122 off while treatmentlaser 112 is fired at target tissue within the treatment boundary.Between subsequent firings of treatment laser 112, control unit 330 mayswitch aiming laser 122 on to redefine or project the treatment boundaryor pattern on the retina. As shown in FIGS. 7A-7F, the resulting visualeffect to an observer may be the nearly continuous appearance of thetreatment boundary or pattern on the retina while treatment spots fromthe treatment laser are sequentially fired and observed on target tissuewithin the treatment boundary or pattern. In some embodiments, such asthe delivery of short duration pulses, the aiming device 130 may becontinuously scanned while treatment laser 112 is fired within thetreatment boundary.

Although shown as separate units, in some embodiments, laser deliveryinstrument 310 and computer system 330 are combined into a single unitso that substantially all the controls and operations are provided froma single unit. Further, as described in more detail below, computersystem 330 may be coupled with a camera 360 (e.g., CCD camera and thelike) to provide the retinal imaging and tracking features describedbelow as well as to display the treatment boundary and/or pattern on adisplay device, such as display interface 320.

Computer system 330 may comprise hardware and/or software, oftenincluding one or more programmable processor units running machinereadable program instructions or code for implementing some or all ofone or more of the methods described herein. The code will often beembodied in a tangible media such as a memory (optionally a read onlymemory, a random access memory, a non-volatile memory, or the like)and/or a recording media (such as a floppy disk, a hard drive, a CD, aDVD, a memory stick, or the like).

FIGS. 4A-4C illustrate various displays that may be displayed on displayinterface 320. Display 410 is shown displaying a treatment pattern 406that includes a square grid of nine treatment areas or locations withinwhich therapeutic light will be delivered onto retinal tissue viatreatment laser 112. The grid may be adjusted using controls 404 so thatthe grid includes a 3×3 array of treatments boxes or locations, a 4×4array of treatment locations, a 5×5 array of treatment locations, or auser defined array of treatment locations. Display 410 also includescontrols 402A-402C that may be used to set or adjust various settings,controls, and/or parameters. For example, control 402A may be used tocontrol a spacing between center points of treatment spots that will bedelivered within each of the treatment locations, or stated differently,define a scale of the treatment pattern. Control 402B may be used tocontrol an orientation of the array of treatment locations with respectto the retina. Control 402C may be used to control an arc and/or radiusof curvature of the array, if desired. FIG. 4A shows treatment pattern406 without an arc and radius of curvature. FIG. 4C shows display 430having an arched or curved treatment pattern 436 including three rowsand six columns of treatment spots. Treatment pattern 436 includes anarc (e.g., 360°) and radius of curvature (e.g., 2000 micrometers) thatare non-zero so that treatment pattern 436 is curved. Display 430similar includes control buttons 432A-432C and 434. FIG. 4B shows adisplay 420 that may be used to adjust or set various parameters of thetreatment laser 112 and/or aiming laser 122. For example, controls ofdisplay 420, which may include touch screen controls, may be used toadjust a duration 422 (e.g., in microsecond intervals) that thetreatment laser 112 is fired, adjust a power level 424 (e.g., inmicrowatts) of the treatment laser 112, and adjust an interval 426(e.g., in microseconds) between sequential treatment laser firings.

Display 420 may be used to adjust the treatment laser 112 betweentraditional photocoagulating procedures and short duration pulseprocedures. Display 420 may also include other controls 428, such as acontrol that selects a port (e.g., 322) to which optic fiber 324 willconnect. As described above, the controls of the display 320 may betouch screen controls or may include rotatable or selectable tabs orbuttons.

Embodiments of Treatment Boundaries and/or Patterns

FIGS. 5A-5F show various embodiments of treatment boundaries and/orpatterns that may be used for the therapeutic treatments describedherein. These treatments boundaries/patterns may be projected or definedon the patient's retina via aiming or scanning laser 122. The projectedor defined boundaries or patterns may be captured by a camera anddisplayed to a user or physician on a display device, such as displayinterface 320. The treatment boundaries/patterns define an area withinwhich the therapeutic treatment is provided and outside of which thetherapeutic treatment is not provided. One advantage of the treatmentboundary process described herein is that the boundaries of thetreatment area are clearly defined, which allows the physician or userto precisely know or determine where the therapeutic treatment will andwill not be provided.

FIG. 5A shows a square or rectangular treatment boundary 510 enclosing asingle treatment area 512 within which one or more treatment laserpulses or doses may be fired. FIG. 5B shows a treatment pattern 520including a grid or array of a plurality of equally sized treatmentsquares or rectangles 522. Treatment pattern 520 is defined byperipheral edges 526 and internal lines 526. FIG. 5B shows a 3×3 array,although any M×N array may be used. FIG. 5C shows an arched or curvedtreatment pattern 530 including an array of a plurality of four sidedgeometric shapes 532. Each shape 532 includes opposing linear sides 536and opposing arcuate sides 534. Treatment pattern 530 may have a radiusof curvature and liner opposing sides 536 may each project radially froma center point. FIG. 5D shows a treatment pattern 540 having a pluralityof hexagonal shapes 542 arranged in a honeycomb pattern. FIG. 5E shows atreatment pattern 550 having a square or rectangular array of aimingspots 552 that define locations where a treatment laser pulse or dosewill be delivered. FIG. 5F shows a treatment pattern 560 having asemicircular array of aiming spots 562 that define locations where atreatment laser pulse or dose will be delivered.

The treatment boundaries, patterns, and/or geometric shapes may beprojected or defined on the retina by controlling a position of theaiming laser (e.g., aiming laser 122) via scanning or aiming device, sothat the aiming laser outlines or defines the treatment boundaries,patterns, and/or geometric shapes on retinal tissue and/or displays thetreatment pattern on a display device or interface. The position of theaiming laser may be adjusted between each of a plurality of pulses todefine or outline the treatment boundaries, patterns, and/or geometricshapes on the retina. The resulting visual effect may be a solid,semi-solid, or pulsing treatment boundary, pattern, and/or geometricshapes defined on the retina as shown in FIGS. 5A-5D.

It should be realized that FIGS. 5A-5D are for illustrative purposesonly and that the treatment boundary/pattern may include various otherarrays of geometric shapes, which may or may not include recurringpatterns.

FIGS. 6A-6F show treatment spots representing the treatment laser beingfired or delivered within the treatment boundaries or patterns ordelivered coaxially therewith. The treatment spots may represent visibletissue damage that occurs when the treatment laser is fired, such as intraditional photocoagulation procedures, or may represent a locationwhere the treatment laser is fired even though no tissue damage isvisible, such as in short duration pulse procedures. FIG. 6A illustratesa plurality of treatment spots 612, which represents locations withintreatment boundary 510 where the treatment laser (e.g., treatment laser112) was or is to be fired. Similarly, FIG. 6B illustrates treatmentspots 622 being fired within each treatment square or rectangle 522 oftreatment pattern 520. FIG. 6C illustrates treatment spots 632 beingfired substantially within a center of each geometric shape 532 oftreatment pattern 530 and FIG. 6D illustrates treatment spots 642 beingfired within a substantial center of each hexagonal shape 542 oftreatment pattern 540. FIG. 6C illustrates embodiments where arcuatetherapeutic treatments are provided and FIG. 6D illustrate embodimentswhere the treatment spots are more tightly or closely spaced. Thetreatment spots of FIG. 6D may overlap with treatment spots in adjacentrows and/or columns. FIGS. 6E and 6F illustrate treatment spots 652 and662 being delivered substantially coaxially with respect to aiming spots552 and 562 of treatment patterns 550 and 560 respectively. In anotherembodiment, larger circles 652 and 662 may represent the definedtreatment patterns and smaller spots 552 and 562 may represent thetherapeutic laser fired or delivered within a substantial center of eachtreatment pattern. Such embodiments illustrate that the definedtreatment patterns or boundaries need not have adjacent geometric shapesthat touch. Rather, some or all of the geometric shapes may be isolatedfrom one or more adjacent geometric shapes.

Although FIGS. 6B-6D show a single treatment spot being delivered withineach of the geometric shapes, in some embodiments multiple spots (e.g.,2, 3, 4, or more) may be delivered within one or more of the geometricshapes. Similarly, the number of treatment spots delivered within eachgeometric shape may be varied to provide additional therapeutictreatment flexibility.

FIG. 8 illustrates a treatment pattern or boundary 810 being positionedadjacent tissue 820 of the retina for which a therapeutic treatment isnot desired. Treatment pattern 810 is positioned adjacent tissue 820 sothat tissue 820 is outside of the treatment pattern or boundary. Tissue820 may be sensitive tissue, a feature of the eye (e.g., fovea, macula,and the like), and/or any other tissue for which the therapeutictreatment is not desired. As described above, treatment pattern 810 maybe projected or defined on the retina so that a physician or user mayposition an outer edge or periphery of treatment pattern 810 adjacenttissue 820. The projection or definition of treatment pattern 810 on theretina allows the physician or user to position the treatment pattern asclose to or distant from tissue 820 as desired while ensuring thattissue 820 is not treated. As also shown in FIG. 8, the therapeutictreatment (i.e., treatment spots 830) is confined within treatmentpattern 810 to ensure that tissue 820 does not receive the therapeutictreatment. The shape of treatment pattern 810 and/or parameters oftreatment pattern 810 (e.g., spacing, radius, row or column number, andthe like) may be changed to accommodate various features of the eye. Forexample, the semi-circular pattern of FIG. 5C may be used encircle aportion of tissue 820 or the fovea. Likewise, the honeycomb pattern ofFIG. 5D may be used to tightly pack treatment spots within the treatmentarea.

Embodiments of Therapeutic Treatment Procedures

In some embodiments, the treatment laser may be fired substantiallywithin a geometric center of each of the geometric shapes as is shown inFIGS. 6B-6D. The treatment spot size of the treatment laser incident onthe retina may be substantially equivalent in size or slightly smallerthan the geometric shape. Further, as previously described, the aiminglaser may be switched off during firing of the treatment laser and thetreatment laser may be switched off when the aiming beam defines oroutlines the treatment boundary or pattern.

The therapeutic treatment pulses or doses (e.g., the spots shown in FIG.6A-6D) may be delivered during a continuous scan of the treatment laserbeam (or more appropriately an axis of the treatment laser beam) throughthe treatment boundary or pattern, or the treatment laser beam may besequentially moved to each target site and the treatment laser firedwhile the treatment laser is temporarily stopped. Continuous scanprocedures may be particularly useful for mircropulse procedures tominimize start and stop times associated with the treatment laser andthereby minimize an overall procedure time. The treatment laser beam(i.e., an axis of the treatment laser) may be continuously scanned rowby row and/or column by column through the treatment boundary/pattern(e.g., similar to a raster scan pattern) until the treatment laser beamreaches a designated end point and/or scans the entire treatmentboundary or pattern. The treatment laser may be sequentially orrepeatedly fired for a defined duration during the continuous scan asthe treatment laser nears each specified target site. The treatmentlaser beam may be repositioned at a starting point of the scan and thecontinuous scan and firing process may be repeated so that additionaltherapeutic treatment is provided to some or all of the previouslytreated retinal tissue (e.g., additional therapeutic treatment isprovided at some or each target site). In another embodiment, thetreatment laser may be stopped or paused at each treatment location anda treatment laser beam repeatedly fired at the treatment location untila sufficient treatment is provided.

In short duration pulse procedures, the interval between therapeutictreatment pulses or doses at the same target site may be sufficientlylong so that the retinal tissue being treated sufficiently relaxes and atemperature of the tissue remains below a threshold of coagulativedamage, thereby minimizing tissue damage. The thermal effect of theshort duration pulse procedure may be confined only to the retinalpigment epithelial layer. In some embodiments, this relaxation interval,or thermal relaxation time delay, may be about 190 microseconds orlonger. Likewise, in some embodiments, the firing duration of thetreatment laser (i.e., the treatment pulse or dose duration) is betweenabout 5 and 15 microsecond, and more commonly about 10 microseconds.

Each scan and firing process (i.e., between defined start and endpoints) may constitute a cycle of a short duration pulse procedure. Theshort duration pulse procedure may involve between about 10 and 10,000cycles. In some embodiments, the treatments laser is fired at 9 or moretreatment sites during each cycle of the scan and each short durationpulse cycle is completed in between about 0.5 and 1.5 milliseconds, andmore commonly about 1 millisecond, although it should be realized thatthe treatment laser may be fired at any number of treatment sites andthe each cycle may include a shorter or longer cycle duration. Further,a therapeutic treatment procedure for a given treatment boundary/patternmay involve a single continuous scan or several continuous scans eachhaving different start and end points.

In an alternative embodiment, the treatment laser may be sequentiallypositioned at each target site and a series of short duration pulses maybe delivered at that target site before moving to the next treatmentsite. Each pulse may be fired for a specified duration (e.g., betweenabout 5 and 15 microsecond, and more commonly about 10 microseconds) andmay have a sufficiently long relaxation interval (e.g., about 190microseconds or longer) so that the retinal tissue at the treatment sitesufficiently relaxes and a temperature of the tissue remains below acoagulation temperature, thereby minimizing tissue damage. The shortduration pulses may be sufficient to induce or provide photoactivationof a therapeutic healing as is commonly known in short duration pulseprocedures. The former short duration pulse embodiment provides theadvantage of allowing the treatment laser to be fired at other treatmentsites during the relaxation interval, thereby minimizing an overalltreatment time.

The short duration pulse procedure may also include delivering theseries of pulses as the treatment laser beam (i.e., the axis of thetreatment laser) is continuously scanned with a specified time intervalbetween each laser pulse or dose so as to provide a predeterminedspacing between adjacent treatment spots. Such procedures may bebeneficial when a treatment pattern having an array of geometric shapes,such as those shown in FIGS. 5B-5D is used and/or when an array ofaiming spots, such as those shown in FIGS. 5E and 5F is used. Thespecified time interval and resulting spacing may be such that eachpulse is delivered within one of the geometric shapes, substantiallywithin a geometric center of each shape, and/or over one or more of theaiming spots.

A therapeutic treatment procedure may involve delivering therapeutictreatment to one area of the retina and then subsequently deliveringtherapeutic treatment to one or more other areas of the retina. Forexample, the aiming device (e.g., aiming device 130) may define a firsttreatment boundary or pattern on a first area of the retina and delivertherapeutic treatment within the defined first treatment boundary orpattern and then subsequently define a second treatment boundary orpattern (i.e., either the same or a different boundary/pattern) on asecond area of the retina and deliver therapeutic treatment within thedefined second treatment boundary or pattern. This process may berepeated as often as desired to provide the therapeutic treatment.

FIG. 9A illustrates an elongated treatment spot 900 resulting fromfiring the treatment laser during a continuous scan process. Thetreatment spot of the treatment laser corresponding to FIG. 9A may havea substantially circular cross section. The elongated spot may occurbecause the treatment laser is continually moving during the firingprocess. As such, even though the short duration pulse firing durationis short (e.g., approximately 10 microseconds), some elongation mayoccur due to the continuous movement of the treatment laser. To minimizethe effects of the continuously moving treatment laser, the crosssection of the treatment spot incident on the tissue may be oval oroblong in a direction orthogonal to the treatment laser path as shown inFIG. 9B. A shown in FIG. 9C, the oval or oblong treatment spot 910 mayfacilitate in producing more circular treatment spots 930 or incidentlight profiles on the retina as the treatment laser beam, or moreappropriately the axis of the treatment laser beam, is scanned acrossthe retina and the series of pulses delivered.

Embodiments of Retinal Mapping/Tracking

FIGS. 10A-10C illustrate embodiments involving retinal maps, profiles,or images that may be used in therapeutic treatment processes, such asthose described herein. FIG. 10A shows a retinal map or image 1000 of apatient's retina that may be captured using one or more cameras (e.g.,camera 360) of a slit lamp or other ophthalmic imaging instrument. Asdescribed above, computer system 330 may be communicatively coupled withcamera 360 to provide retinal mapping, imaging, and/or tracking.Computer system 330 may have a measurement device capable of generatingimages 1000 of the retina 1012 and of providing information helpful fordetermining a treatment area or areas and/or treatment pattern orpatterns to treat with the therapeutic treatment. A beam, such astreatment beam 112 may be directed toward a treatment area of the retinaby referencing retinal image 1000. The beam may provide the therapeutictreatment. Indicia, such as treatment spots, may be superimposed onretinal image 1000 at a location corresponding to the treatment area todocument or record the therapeutic treatment provided. For example,treatment spots or other indicia may be superimposed on retinal image1000 at each location that the beam is fired. The plurality ofsuperimposed treatments spots may display the therapeutic treatmentprovided. The beam may then be repositioned to another treatment area ofthe retina by referencing the retinal image and a second therapeutictreatment provided and/or documented with superimposed treatment spotsin the manner described above.

In some embodiments, a treatment area, boundary, and/or pattern 1020 maybe referenced to the image 1000, so that a relationship between thelocation of the treatment area, boundary, and/or pattern 1020 and theimage 1000 data can be established. The treatment area, boundary, and/orpattern 1020 may be linked to a feature or reference location 1010 onthe retina 1012, which can be identified in the image 1000, such as avarious veins, arteries, the optic disc, macula, retinal landmarks orfeatures, and the like. Along with locating and/or determining thetreatment area, boundary, and/or pattern 1020, the measurement device(e.g., computer system 330) may also include at least a portion of aprocessor system capable of calculating a set of treatment instructionsto be used by a therapeutic treatment deliver system, such as adapter100 and slit lamp 200.

The measurement device (e.g., computer system 330) and/or therapeutictreatment system (e.g., adapter 100 and slit lamp 200) can have softwarestored in a memory and hardware that can be used to control the takingof images and delivery of therapeutic treatment (e.g., treatment laser112) to the patient's retina, the location or the position (optionallyincluding translations in the x, y, and z directions and torsionalrotations) of the patient's eye relative to one or more optical axes ofthe imaging assemblies, and the like. In exemplary embodiments, amongother functions, computer system 330 (e.g., the measurement device) canbe programmed to calculate treatment areas, boundaries, and/or patterns1020 based on the image(s) taken with camera 360, and measure the offsetbetween the patient's eye in the two images. Additionally, computersystem 330 can be programmed to measure, effectively in real-time, themovement or position x(t), y(t), z(t), and rotational orientation of thepatient's eye/retina relative to the optical axis of the laser beam(e.g., treatment laser 112 and/or aiming laser 122) so as to allowcomputer system 330 to register or align the desired treatment areas,boundaries, and/or patterns 1020 on the real-time position of thepatient's eye.

In order to register the desired treatment areas, boundaries, and/orpatterns 1020 of the patient's eye during the treatment, the images fromthe patient's retina taken by the camera 360 should share a commoncoordinate system. The common coordinate system may be based a center ofthe pupil or inner iris boundary, a center of the outer iris boundary, acenter of various veins or arteries, a center of the optic disc ormacula, a center of other retinal landmarks or features, or any othersuitable feature of the eye.

As shown in FIG. 10B, one or more desired areas to treat with thetherapeutic treatment may be determined with reference to diagnosticdata associated with a first retinal image 1000 that is captured bycamera 360 and/or previously obtained and input into computer system330. A treatment area, boundary, and/or pattern 1020 to use for eachrespective treatment area may then be determined. These determinationsmay be made by a physician with or without the aid of computer system330, or, in some embodiments, may be made automatically by computersystem 330. Each treatment area, boundary, and/or pattern 1020 may bethe same or may vary.

In some embodiments, the one or more desired treatment areas,boundaries, and/or patterns 1020 may then be programmed into computersystem 330. Computer system 330 may operate with camera 360 to determinean area of the patient's retina 1012 that corresponds to the programmedtreatment area(s) by comparing the patient's retina and retinal image1000. In some embodiments, a second image of the eye is captured bycamera 360, such as immediately prior to the therapeutic treatmentprocedure, and the two images are processed or compared to generateretinal treatment location information, which information may then bereferenced to the second image. The treatment area(s), boundary(s),and/or pattern(s) may be superimposed on the patient's retina and/ordisplayed on a display interface (e.g., touch screen display 320) priorto the therapeutic treatment procedure in order to display thetreatment(s) that will be provided and the areas that will receive suchtreatment(s). A physician or user may evaluate the treatment(s) and, ifdesired, modify or adjust a property (e.g., orientation, scale,boundary, pattern, and the like) of one or more of the treatments.

In some embodiments, computer system 330 may instruct adapter 100, orsome component of a therapeutic treatment system, to fire an aiminglaser beam (e.g., aiming laser 122) onto the determined treatment areaof retina 1012 to define the treatment boundary and/or pattern 1020 onretina 1012. In other embodiments, a treatment boundary and/or patternmay not be defined on the retina and, thus, an aiming laser may not beneeded.

Computer system 330 may also instruct laser delivery instrument 310, orother therapeutic treatment system component, to direct a therapeuticlaser beam (e.g., treatment laser 112) onto the retina 1012 within thetreatment area and/or within the treatment boundary and/or pattern 1020defined by the aiming laser beam. The second laser beam (e.g., treatmentlaser 112) may deliver the desired therapeutic treatment pulses or doses1030 (e.g., short duration pulse or other treatment) to retinal tissuewithin the defined treatment area and/or treatment boundary and/orpattern 1020 as shown in FIG. 10C.

The retinal image 1000 may be stored in a memory device and/or databasefor immediate or future reference. As briefly described above, thetherapeutic treatments 1030 provided on the retinal tissue 1012 may bedocumented or recorded on the retinal image 1000 in order to track thetreatment or treatments the patient receives. Documenting/recording ofthe therapeutic treatments provided may involve monitoring a position ofthe treatment laser beam 112 (i.e., a position of the laser beam axis)with respect to retinal image 1000 and recording each position of thetreatment laser beam when the treatment laser 112 is fired. Individualtreatment spots or locations may be recorded on retinal image 1000 todisplay the areas that have received treatment. Such mapping anddocumenting/recording procedures may be particularly useful in shortduration pulse treatment procedures where no visible effects of thetherapeutic treatment are present and previous short duration pulsetreatments may otherwise been unknown.

Similarly, a plurality of therapeutic treatments to provide to a patientover one or more treatment sessions may be mapped or imaged on retinalimage 1000. Each therapeutic treatment subsequently provided may bedocumented or recorded on retinal image 1000, or a second retinal image,so that the actual therapeutic treatments provided may be compared withthe therapeutic treatments mapped or imaged in order to track an overalltreatment status of the patient or determine the progress of thetreatments and the patient's response to such treatments.

Computer system 330 and camera 360 may also be used to adjust thetherapeutic treatment system (e.g., treatment laser 112 and/or aiminglaser 122) in response to movement of the patient's eye. For example,computer system 330 may reference retinal image 1000 with one or moreother images provided by camera 360 to determine whether the patient'seye has moved. In response to movement of the eye, the position of theaiming laser 122 may be adjusted so that the projected or definedtreatment boundary/pattern maintains a correct orientation with respectto the retina. Likewise, the position of the treatment laser 112 mayalso be adjusted to compensate for movement of the eye to ensure thatthe treatment laser 112 is fired within the adjusted treatment area,boundary, and/or pattern. The adjustment may include determining a newposition of retinal features of the eye (e.g., veins, arteries, macula,and the like), determining a new position of the treatmentboundary/pattern based on the new position of the retinal features, andadjusting the aiming device 130 accordingly. The images captured bycamera 360 may be provided to computer system 330 and compared withretinal image 1000 in real time to provide real time tracking andadjustment of the therapeutic treatment based on movement of the eye.

Having described several embodiments, it will be recognized by those ofskill in the art that various modifications, alternative constructions,and equivalents may be used without departing from the spirit of theinvention. Additionally, a number of well-known processes and elementshave not been described in order to avoid unnecessarily obscuring thepresent invention. Accordingly, the above description should not betaken as limiting the scope of the invention.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimits of that range is also specifically disclosed. Each smaller rangebetween any stated value or intervening value in a stated range and anyother stated or intervening value in that stated range is encompassed.The upper and lower limits of these smaller ranges may independently beincluded or excluded in the range, and each range where either, neitheror both limits are included in the smaller ranges is also encompassedwithin the invention, subject to any specifically excluded limit in thestated range. Where the stated range includes one or both of the limits,ranges excluding either or both of those included limits are alsoincluded.

As used herein and in the appended claims, the singular forms “a”, “an”,and “the” include plural referents unless the context clearly dictatesotherwise. Thus, for example, reference to “a process” includes aplurality of such processes and reference to “the device” includesreference to one or more devices and equivalents thereof known to thoseskilled in the art, and so forth.

Also, the words “comprise,” “comprising,” “include,” “including,” and“includes” when used in this specification and in the following claimsare intended to specify the presence of stated features, integers,components, or steps, but they do not preclude the presence or additionof one or more other features, integers, components, steps, acts, orgroups.

What is claimed is:
 1. A method for treating an eye of a patientcomprising: delivering a first beam from a first light source along afirst path to an aiming device; delivering a second beam from a secondlight source along a second path to the aiming device, the second pathbeing off-axis from the first path; projecting, via the aiming device,the first beam onto retinal tissue of the patient's eye; defining, viathe first beam, a boundary on the retinal tissue separating the retinaltissue to a first area and a second area, the boundary including aplurality of continuous and connected geometric shapes; and delivering,via the second beam, a therapeutic treatment to the retinal tissue ofthe patient's eye by selectively directing the second beam onto theretinal tissue of the patient's eye within the first area; wherein thefirst beam is switched off during firing of the second beam and thesecond beam is switch off during firing of the first beam, and whereinthe first beam is switched on between subsequent firings of the secondbeam to redefine the boundary on the retinal tissue between subsequentfirings of the second beam, the first beam being projected onto theretinal tissue so that a resulting visual effect is a continuous solidboundary of the continuous and connected geometric shapes on the retinaltissue.
 2. The method of claim 1, further comprising: positioning theboundary adjacent an identified region of the patient's eye so that theidentified region is within the second area, the identified regionincluding tissue that is not to be treated with the treatment; anddirecting the second beam within the first area so as to avoiddelivering the therapeutic treatment to the tissue of the identifiedregion.
 3. The method of claim 1, each geometric shape defines an areawithin which the second beam is directed to deliver the treatment, thesecond beam being directed within each of the geometric shapes.
 4. Themethod of claim 3, wherein the first beam outlines the plurality ofcontinuous and connected geometric shapes on the retinal tissue.
 5. Themethod of claim 4, wherein the location of the first beam is adjustedbetween each of a plurality of pulses.
 6. The method of claim 3, whereinthe geometric shapes comprises one or more of the following: a gridhaving a plurality of squares; a grid having a plurality of rectangles;a semicircle pattern, a pattern of circles, and a hexagonal pattern. 7.The method of claim 3, further comprising directing the second beam overa geometric center of each of the geometric shapes.
 8. The method ofclaim 7, wherein a spot of the second beam incident on the retinaltissue is entirely within a periphery of the geometric shape formed bythe first beam.
 9. The method of claim 1, further comprising deliveringa plurality of pulses of the second beam within the boundary to providethe treatment.
 10. The method of claim 1, further comprising adjustingeither or both a scale of the boundary and an orientation of theboundary.
 11. The method of claim 1, wherein defining the boundarycomprises directing the first beam along a periphery of the boundary.12. The method of claim 11, wherein the first beam has a visible spotsize on the retina that is smaller than a spot size of the second beam.13. The method of claim 1, wherein delivering the therapeutic treatmentcomprises causing photocoagulation of the retinal tissue.
 14. The methodof claim 1, further comprising delivering the second beam in a series ofpulses of sufficiently short duration so as to avoid inducingtraditional photocoagulation of the retinal tissue while inducingphotoactivation of a therapeutic healing response.
 15. A method forproviding therapeutic treatment to a patient's eye, the methodcomprising: defining, via an aiming beam, a treatment pattern onto aretina of the patient's eye, the treatment pattern defining a first areaof retinal tissue and a second area of retinal tissue, the treatmentpattern comprising a plurality of geometric shapes within the firstarea; and delivering, via a treatment beam, a therapeutic treatment toretinal tissue of the first area by selectively directing the treatmentbeam within an interior region of each geometric shape of the pluralityof geometric shapes, the treatment beam being delivered along a paththat is different than a path of the aiming beam; wherein the aimingbeam is switched off during firing of the treatment beam and is switchedon between subsequent firings of the treatment beam to redefine thetreatment pattern on the retinal tissue resulting in a continuousappearance of the geometric shapes being provided on the retinal tissue.16. The method of claim 15, wherein the treatment beam is sequentiallydirected within each of the geometric shapes.
 17. The method of claim16, wherein the treatment pattern comprises a grid having a plurality ofrows and columns, and wherein the treatment beam is sequentially scannedalong the plurality of rows and columns to deliver the treatment beam tothe retinal tissue.
 18. The method of claim 17, wherein the gridcomprises an M×N array of squares or rectangles arranged in a linear orsemicircular pattern.
 19. The method of claim 15, further comprising:defining a second treatment pattern onto the retina at a location thathas not received the treatment, the second treatment pattern defining athird area of retinal tissue and a fourth area of retinal tissue; anddelivering, via the treatment beam, the therapeutic treatment to retinaltissue of the third area by selectively directing the treatment beamwithin the third area.